Adventures with the Medical Trade: a memoir

Wednesday, May 2, 2012

I have been thinking lately of an essay I read many years
ago, back when I was an undergraduate in college. The relentless cycles of chemotherapy and recovery
leading to yet more chemotherapy and yet another recovery followed by…. well, the cycles are relentless.

In the very first sentence of “The Myth of Sisyphus,” Albert
Camus asserts (and then defends) the notion that “There is but one truly
serious philosophical problem, and that is suicide. Judging whether life is or
is not worth living amounts to answering the fundamental question of
philosophy. All the rest—whether or not
the world has three dimensions, whether the mind has nine or twelve categories—comes
after.”

A week before I started chemotherapy, I was reminded of that
essay and its fundamental question by my oncologist. I asked him a rather simple question: How long will I be on chemotherapy? His answer:
as long as you think you can take it and as long as it’s keeping the
mass at or about the same size or shrinking it.

To a very large extent, whether they have read Camus or not,
every cancer patient undergoing chemotherapy for indefinite periods of time
must come to terms with Camus’s question:
to continue the devastating regimen of chemotherapy or to stop the
cycles of near death and recovery. They
may not consider themselves existentialists, but their doctors offer them a
clear choice and (at the risk of being overly dramatic) that choice is to live,
with the suffering that implies, or to stop all of the suffering and die.

Let’s, for one moment, revisit the actual myth of
Sisyphus: He was indefatigable. He sinned often and joyously against the gods
and all of those sins and the accompanying joy are a part of the myth, but his
great sin was getting permission to leave the Underworld to return to his old
life in order to chastise his wife. Once
back on the green earth, he found it good, got lost in contemplation of the
beauty of the ocean, of the sun, and refused to return to the Underworld. Pluto, enraged by this Sysiphusian behavior,
dispatches Mercury to bring him back to where, as Camus writes, his stone
awaits him.

His stone awaits him, my stone awaits me, your stone awaits
you. A pretty conjugation, no? It reminds me of that other statement about
human suffering: that each of us has his
own cross to bear. For Sisyphus is condemned
to roll a huge stone to the top of the high hill and, when he reaches the
summit, to see the stone roll back down to the valley below. Sisyphus walks back down the hill to begin
the task again. Immediately, we can see
correlations with our own lives and the lives of those around us, clichés like “the
rat race,” “the treadmill” and others come to mind. It is when we become aware that we, too, are
pushing that stone up the hill that we become, what?, not tragic, perhaps
pathetic, at the very least aware of an existential question concerning whether
it is worth it to continue or not. But I
am getting ahead of myself.

Camus is concerned not with the rolling of the stone up the
hill, though his description of that is brilliant, lyrical, but with those moments when Sisyphus sees the stone rolling back down the
hill and begins to walk back down. That
is the moment of the “absurd,” that moment when we are not buried in the task,
but have time to think about how meaningless it all is. That moment of awareness, of consciousness
about who and what we are, is the moment that makes both tragedy and pathos
possible. Camus reminds us that for
almost all of his life, until the final hours we see acted out on the stage,
Oedipus walked blindly through life—happy, content in his wife and
children. And then he ripped the veil
away and entered the world of the tragic hero.
There is a kind of joy in his triumph over fate, his ripping the world
apart to enable himself to see at his moment of blindness. He is not defeated; he is triumphant as he is
led away by his daughter Antigone, her moment of apotheosis still to come.

I do not want to belabor a much labored over point, but that
moment of awareness also leads to what we now call an “existential” decision: is life worth living? Oedipus decides that it is in Oedipus at Colonus and tells Theseus: "Oh
Theseus, dear friend, only the gods can never age, the gods can never die. All
else in the world almighty Time obliterates, crushes all to nothing..."
but that life is worth living: “Despite
so many ordeals, my advanced age and the nobility of my soul make me conclude
that all is well.”

And so, we return to the beginning: how chemotherapy maintenance is similar to
that integral question salient to philosophy:
the matter of suicide and the story of Sisyphus. The moment of the absurd, the moment of true
self-awareness. Let’s come down from the
heights to the lower-level existence for a chemotherapy patient: me.
Chemotherapy comes in cycles: one
day: IVs filled with chemicals designed to kill blood cells are infused into my
body. The next day, I feel good but have
to go back to the clinic to have a shot designed to help restore white blood
cells. The next morning, I am rolling stones
up the hill, sick, exhausted, trudging on, falling asleep off and on. Not pain!
I have felt no pain except for the insertion of IVs. For a week, I feel almost like answering yes
to that essential philosophical question, but I resist.

In the second week, the chemo stone rolls back down hill and
I can breathe again or could except for San Antonio’s allergens.

I feel good, enjoy driving around with the
top down, go to work every day. It is in
the third week that the existential question arises. I feel normal. I play golf.
I go to the club and walk on the treadmill, run a little. Goddamn but I am fully human again! But the week moves on and I am walking down a
Sisyphusian hill. The huge stone grows
larger in my sight. Monday will be chemo
day and the whole thing will start again.

Do not get me wrong.
I am no kind of hero. I am not
Oedipus or Sisyphus, am merely a person, one of billions and one of thousands
undergoing this treatment schedule.
Ultimately, though, we all have to make the Sisyphusian choice: to go on or not to go on. That is, I think, what Samuel Beckett’s Waiting for Godot is all about. Gogo and Didi see no real purpose in their
lives except to wait for Mr. Godot who never appears. “Let’s go on,” Didi says, and they do…or they
don’t. Not heroes, just people, like you
and me.

They go on and I go on.
We all have the option to stop. Beckett
is positive as are Oedipus and Sisyphus.
As am I. I could not have written
this last week when I had my most recent chemotherapy treatment; I would not
have had the energy. I can’t not write it this week even if it’s
not terribly interesting.

As I said at the beginning, I first read Camus’s “The Myth of Sisyphus” back when I was
an undergraduate, some decades ago, perhaps a decade after Camus wrote it. I was 18 years old and besotted with the "Theatre of the Absurd" and French intellectuals. Camus's essay has held up under the years much better
than I have. It remains, for me,
essential reading. Essential? Yes, because it makes people think about things we really do not want to think about.

Wednesday, March 14, 2012

It’s been a few weeks since I’ve posted to this blog but, basically, I’ve just been very very tired and very busy at the same time.I got off my maintenance schedule when I went to Lamar last month and pushed chemo back (with the oncologist’s approval) for a week.That was fine.I felt really good the whole time I was in Beaumont…except for my voice.But that meant I had chemo (after returning to San Antonio) only a week before AWP in Chicago and, so, had to cancel my trip to Chicago.

I hated missing that trip but love the video greetings from the Pecan Grove Press poets who partied on.Louie Cortez did a great job of getting the party together at the Gage Art Gallery and of selling books from the PGP table!

Meanwhile, back in San Antonio, I didn’t fully recover from the delayed chemo treatment until late last week.I am now back, pretty much as healthy as I have been, and will not have another chemo drip until next week.

That “pretty much as healthy as” refers to the fact that I am exhausted again.Sunday night (err, Monday morning) at 2 a.m., Susan woke up with a terrible pain in her chest that radiated through to her back and to her left arm.I rushed her to the emergency room at Stone Oak Methodist Hospital where it took doctors until last night to determine that her heart was fine and that the pain was probably gastric in nature.She’s fine now, but it was scary!I stayed with her in the hospital both of the full nights she was there.And got very little sleep.

It was a role reversal as Susan has been trying to sleep on those uncomfortable chairs whenever I’m in the hospital!

Right now, I’m tired (okay, just tired) and about to go back to sleep.

Thursday, February 2, 2012

Unfortunately, the road to recovery takes people down some interesting byways and pathways.Last week I reported on how well I was doing: lung cancer no longer detectable for X-Ray, playing a fairly normal game of golf, etc.But since Friday of last week, I have been a fragile, sickly guy who feels his age.

Friday, I went in to the START Center for hydration—a two-hour I/V drip that adds a liter of saline solution to your body.That makes me feel good immediately.I walk better, have a more pleasant disposition, and, hey, people seem to like me again.

That same Friday, I made an appointment with my pulmonologist for the following Monday.Why?I have this very nasty cough that the Onc Docs don’t seem to think is caused by the cancer.The Pulmonologist prescribes 4 different sprays, some of them to be applied twice a day plus a huge series of antibiotics called Amoxy-Clav.I thought I might bead them all into a necklace.Please note:no pain, just that annoying exhausted feeling.Wednesday, I crawled out of bed and decided I did not feel strong enough to go to Dean’s Council meeting.Instead, Susan toodled off to teach future educators and I went in for more hydration.

I got home at about 11 a.m. and Susan was already there:her lower leg tightly bound with an Ace bandage, ice wrapped around her foot.It’s been wet in San Antonio lately and the cedar pollen has joined my second favorite allergy:molds.But the wetness also made the stairway at the school slick and wet.So, ker-blam!!!

I called the San Antonio Orthopedic Center.I explained carefully to the appointments people that she need to have her foot looked at.And then I made a mistake.They asked if she had seen any of their doctors before.I said, yes, Dr. Brad Tolin, when she had knee replacement.So, the little twit came back and told me we had an appointment with Dr. Tolin at 3 p.m.I started to remind her that “we have” a foot problem, not a knee problem.She said “no problem” and hung up.

We walked into the Orthopedic Center and signed in.Susan had to fill out twenty pages about herself and the nurse at the desk said, “Dr. Tolin only sees knees.”I told her I knew that but the incompetent little twit making reservations didn’t seem to hear a work except Tolin had been her doctor once.So, I told her, let’s get the knee x-rayed and the foot.At that point she informed me that she would need a doctor to order a foot x-ray.We forget, perhaps because they do save lives, that the medical profession is as bad and bureaucratic and incompetent as any other profession.

Tolin’s okay.He had her knee x-rayed and also ordered an ankle/foot x-ray: a small bone chip at the top of the foot. He referred her to a foot doctor colleague of his and we were off:Susan sporting a fancy new pump-up boot.

Thursday, January 26, 2012

So, maintenance chemo again yesterday afternoon, followed by a B-12 intramuscular injection and then a Neulasta shot this morning.The injections are to stave off some of the damage done by the chemo.The numbers:I have now had nine (9) IV drips of Avastin.Each injection costs right at $12,564.80 for a total (thus far) of $113,083.20.The Alimpta costs $1.80 less per drip; so, the cost if approximately the same.I’m fortunate in that I have decent health insurance from my university.I wonder, though, about those not old enough for Medicare and who cannot afford health insurance and do not have an employer that provides health benefits.This is part of why we need the Affordable Health Care Act or, as its detractors call it, Obamacare…and sometimes even RomneyCare.

I am also aware that the costs provided by my health insurance company are not realistic.Those are the costs provided by Genentech and other drug manufacturers.The cost paid by health insurance providers have been negotiated downwards from the peak cost by a goodly percentage.And that is why the Republican deal not to allow Medicare to negotiate with suppliers is so noxious and is so expensive to the government.Okay, no more politics in this blog entry.

So, the previous time I went in for maintenance therapy (chemo therapy by another name), I developed a bad case of the flu. Remember: chemo reduces your natural immune system's ability to protect you.It took two weeks to get rid of that with powerful antibiotics and, as soon as I did, the billions of cedar trees between here and Fredericksburg and north to just west of Fort Worth decided to get sexual and spread their pollen.So, I continue to sneeze and cough though the flu is gone.Neither here nor there.Doc Onc1 tells me that my lung cancer is no longer visible on X-Rays and that the chemo has shrunk it remarkably on the CTscan displays.That’s pretty remarkable since the diagnosis of Stage-4 lung cancer was a definite death sentence less than ten years ago.

I am typing this from work this morning and am rushing through it…do bear with me if some sneaky little grammatical problems creep into some of the sentences.But, it’s a beautiful day and I ventured to work with the top down in spite of pollen dancing in the air and am, off and on, sneezing onto my keyboard.I do hope you catch nothing from all that.

We have re-jiggered my maintenance schedule so that I can go to Beaumont for a reading at Lamar University (they’re actually going to pay those of us who are reading!) and then fly to Chicago on Leap Day for the annual conference of the Association of Writers and Writing Programs (AWP) where I’ll be hosting a party at the Gage Gallery (arranged by my former St. Mary’s Colleague, Scott Blackwood—a fine fiction writer).By the time I return, the cedar trees should have ceased their winter frolicking and I should have stopped sneezing and coughing.

Two more doctors to see in the next three weeks:my pulmonologist and my cardiologist.Crap!Add in my ophthalmologist.More after those visits.

Tuesday, January 17, 2012

Perhaps the only real downside of living in San Antonio, Texas, is the fact that we have a huge arc of millions, perhaps billions, of juniper cedar trees to our north and west. Each year at about this time, the junipers get randy and start broadcasting their pollen. We call them “mountain cedar,” but they’re really juniper ash trees and they are, as one web site calls them, the “plague of trees.”

“The Allergy, Asthma and Immunology Clinic of Georgetown, Texas has a web site describing the awful effects of cedar allergies http://hovanky.com/allergy/mountain.htm . From December through February, many people experience an itchy, runny nose, sneezing, nasal blockage, excess tearing and itchy eyes. Others complain of itching of the palate, throat, or ears, and postnasal drainage. Some have fatigue, mild headache, facial discomfort, sore throat, partial loss of sense of smell, and sensation of ear plugging. If you experience the above symptoms every year during these months, the chance is great that you have Mountain Cedar allergy.”

Just after Christmas, local television weathercasters predicted that the next day we would receive 1,800 units of cedar pollen per whatever they use to measure the damned stuff. Instead, we got 21,000 parts per…. That’s nice and academic. Look at the list of symptoms up there and please note that I NOW HAVE ALL OF THEM PLUS MY VOIC IS GONE. People assume I am coughing and acting close to death because I have cancer, but it’s the allergens in the air.

I have been back to Doc Onc1 since my last report: low platelets, high white blood cells, the adenocarcinoma is in retreat still. But I am getting extra liters of IV drips to replenish my dehydrated body. I may wind up wearing one of those silly little masks everywhere until the end of February, perhaps my voice will come back.

In the midst of all this, I may have to go see an allergist. I may wind up walking in a haze of strong antihistamines, shooting myself with whatever mix the allergist comes up with, along with my insulin shots. I may be able to breathe again, to function again. And I suppose it would have been worth it after all. I suppose.

Wednesday, January 4, 2012

I had the second of what will be many maintenance chemotherapy treatments yesterday and feel pretty good today.I need to feel this good tomorrow when we have a sales rep from a major library furniture vendor coming to present a new line of furniture.Usually, after-effects from chemo are felt the second and third days after treatment.Maintenance therapy, though, is supposed to have a much less strenuous effect on the patient.

Good news yesterday was that all the blood work (including those naughty platelets) was normal.So, I sat in the recliner re-reading Moby Dick and waited for the 2 and a half hours of IV to finish dripping in.That’s much better than the old four-hour IV drip (though I would have made more headway on Melville).

Nurse Maggie, my IV nurse, is a wizard with needles and always manages to get the IV in with the first thrust.Much different from the male nurse at my gastroenterolgist’s office who jammed the needle through the vein and quoted Rick Perry (“ooops!”).That attempt oozed for three days before stopping.Nurse Maggie is one of a platoon of fine nurses working in the treatment room (AKA Cancer Ward) and responds, in a nearly Pavlovian way, to the beep beeps when an IV bag empties itself into the vein and then rushes over to attach the next bag.I get four bags a visit now:two for chemo and two to flush the vein.Before maintenance I had six bags full (Baa Baaa Baaaa).

And so, it continues.I do have a cough, but the Docs Onc say the cough is not caused by the cancer and are referring me to a different Doc to see about that.The ENT Doc couldn’t do anything but prescribe Benzonate (didn’t work) and, so, we’re trying a trip back to the pulmonologist this time.Doc Rafael is the doc who first caught this thing, these things, whatever.So, maybe he can do something about my waking up coughing at night.We’ll see.

Anyway, it’s a beautifully brilliant day here in San Antonio and I am in my office instead of being out in the sun’s rays swinging long sticks at dimpled balls.Three more weeks before the next chemo treatments and a bit more than a month before I head to Chicago for the national meeting of the Association of Writers and Writing Programs.That last should be great fun.

Tuesday, December 20, 2011

Okay, every day people are getting colds…no big deal.But Saturday I slept from 4 p.m. to 11 a.m. Sunday (19 hours for a person who has always needed 6).Then, went back to sleep from 3 p.m. Sunday until 10:30 a.m. (19 hours. 30 minutes) on Monday.When I was much younger and pulled all-nighters at bars and libraries, I could do that.These days, no.

Yesterday morning (that same Monday), I called Doc Onc1 (I’m supposed to do that if something odd happens).Here’s the odd thing that was happening:bad headaches, flatulence and belching (gross, I know), sore joints, sore lower stomach, sneezing, low-level fever. (Plus, my sister-in-law was visiting--that's a good thing, by the way)The doc called back within five minutes and had set up an appointment for me to get a chest X-ray at STRIC, had set up an appointment with my superb PCP, and had set up an appointment with him.My medical life was flashing before my eyes!Everyone except my pulmonolgist, my nephrologist, my urologist, and my gastroenterologist).

The X-ray was negative.Even trained X-ray technicians can no longer see the lung cancer, but the X-ray did pretty much rule out pneumonia.Next, to the PCP's office:a nose swab. I hate those!I sneeze for thirty minutes afterwards.That ruled out the flu! Everyone is listening to my lungs...clear.

An hour later, I dragged myself into the START Center for Cancer Treatment.No pneumonia, no cold.Doc Onc1 said, “H. Palmer Hall, you have a cold.”*sigh*But they also did a Complete Blood Count (CBC) and my platelets were down to 77 after last Tuesday’s maintenance chemo.Not so low as to be dangerous (I was at 21 two weeks earlier!), but low enough that they wanted to do something about it.What?An IV drip of Saline Solution to rehydrate me.That took an hour and a half!

A couple of you have asked precisely what “maintenance therapy” is.So:

About five years ago, oncologists got tired of watching their lung cancer patients die.Two of my friends died of lung cancer that year:Carla Saenz and Cynthia Harper.Carla was the Community Relations Director for the largest Barnes & Noble in town and that store donated $1000 to Pecan Grove Press each year plus readings to all of my San Antonio authors.Cynthia was a superb poet and dear friend.As editor of Chili Verde Press, she published my first two chapbooks:From the Periphery and Deep Thicket & Still Waters.We had lunch every Wednesday at the Blue Star Brewery.I continue to miss them both very much.

So, when I found out that I, too, had lung cancer, I became almost fatalistic.Until I met the oncologists at the START Center.For the past five years, oncologists have been debating something called “maintenance therapy.”It works like this:They give you large amounts of chemotherapy (in my case carboplatin, limta, and avastin) for six visits (one each month in my case) and then they check you out with MRIs, PetScans, blood workups.If there has been sufficient shrinkage of the tumors, they give you two additional rounds of major chemo. This brings you close to death, but should kill off most of the remaining bad cells. And then, they move you to maintenance.An additional series of scans prior to maintenance showed that the brain cancer was gone, nothing left but scar tissue (oh, yes, plus the original gray mass that passed for a brain).

Maintenance, in my case, includes similar treatment to pre-maintenance, but the carboplatin is left out.The IV drip last for 2.5 hours and not 4.The after-effects are supposed to be neglible, but “H. Palmer Hall has a cold!”

Maintenance remains a fairly new therapy for oncologists and is still debated.Some maintenance patients have been on maintenance for all five of the years doctors have been doing it.There is no guarantee, but I feel pretty good abut it.

There are two possible goals, neither with guarantees:1) remission and 2) new therapies coming along.

So, there it is.I have a cold.But with chemo reducing my immune responses, colds are a bit harder on the body than they used to be.

About Me

I'm the library director at St. Mary's University. My own books include: The Librarian in the University (Scarecrow Press, 1990); A Measured Response (Pecan Grove Press, 1992); From the Periphery (Chile Verde Press, 1993); Deep Thicket and Still Waters (Chile Verde Press, 1995); To Wake Again (Pudding House Press, 2005); Coming to Terms (Plain View Press, 2007);Reflections from Pete's Pond (PGP, 2007). Foreign and Domestic(Turning Point Press, 2009. A new collection of short stories, Into the Thicket, came out from Ink Brush Press in early 2011 and a collection of essays and poems called Big Thicket Elegy was published by PGP in 2011. I've published various articles in library journals and more than a hundred poems, stories and essays in various literary reviews and anthologies. My personal website is at http://library.stmarytx.edu/palmer